Lupus Skin Rash
Reviewed by: HU Medical Review Board | Last reviewed: January 2020 | Last updated: May 2020
Most people with lupus will experience rashes and sores (lesions) on the skin at some point in their lives. In fact, 66 percent of people with lupus will develop some form of skin disease, according to the Lupus Foundation of America. Lupus was first described by doctors as a dermatologic (skin) condition.1
Lupus rashes may occur from head to toe. Lupus rashes may be confused with rosacea, sunburn, or an allergic reaction.2
Types of lupus rashes
People with lupus get several different kinds of rashes, including:
- Photosensitivity rash
- Malar ("butterfly") rash
- Discoid lesions
A photosensitivity rash is a reaction to light or sun that happens in 40 to 70 percent of people with lupus. These rashes most often appear on areas of skin that were exposed to the sun, such as the neck, ears, or back of the hands. Photosensitivity rashes can look like sunburn or develop into scaly, flaky lesions. Many people with lupus find that sun exposure makes their skin issues worse or triggers other symptoms such as joint pain, fatigue, and fever.1-4
Malar ("butterfly") rash
A malar rash is a raised, red, butterfly-shaped rash that spreads across the cheeks and nose. In some, malar rash signals that a flare is about to occur or follows sun exposure. It occurs in about half of people with lupus.3
Hives (urticaria) appear in about 10 percent of people with lupus and often look like a raised or swollen rash. While hives caused by allergic reactions tend to last a short time, lupus hives often last longer than 24 hours.3
Discoid lesions (sores) may appear only on the head or neck, or anywhere on the body, especially on sun-exposed skin. These sores look like well-defined, disk-shaped patches that expand when lupus is active. Discoid lesions often cause scarring and loss of pigmentation (color) of the skin.4
Who treats the skin issues of lupus?
Your rheumatologist may treat any skin issues you have, but serious skin complications or skin cancer may require a dermatologist, a doctor who specializes in treating skin conditions.
How are skin complications treated?
Many options exist to treat skin issues common to people with lupus. The type of treatment your doctor recommends will depend on the skin issue you have. Treatments include:1
- Topical steroid ointments, creams, or gels that you spread on the skin may be prescribed to reduce inflammation and soothe itchiness and flaking.
- Immunosuppressant creams and ointments may be used instead of steroid topicals.
- Liquid steroids may be injected directly into serious skin lesions (sores).
- Thalidomide is sometimes used to improve cutaneous lupus that does not respond to other treatments.
- Gold, given in oral or intramuscular (shot) form, may be prescribed for severe skin disease.
- Avoiding sunlight and fluorescent lights can help control the rashes caused by photosensitivity. This includes wearing sunscreen of at least SPF 30, staying indoors as much as possible and wearing protective clothing such as wide-brimmed hats.
Since lupus can increase your risk of developing skin cancer, especially if you have discoid lupus, you may need skin cancer screenings more often than is recommended for people without lupus.2
Taking all of your lupus medications regularly can help control the inflammation that causes skin rashes and lesions.